STATE AND LOCAL POLICY INITIATIVES
TO REDUCE HEALTH DISPARITIES

Workshop Summary

Karen M. Anderson, Rapporteur

Roundtable on the Promotion of Health Equity and the
Elimination of Health Disparities

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

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STATE AND LOCAL POLICY INITIATIVES TO REDUCE HEALTH DISPARITIES Workshop Summary Karen M. Anderson, Rapporteur Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This project was supported by contracts between the National Academy of Sciences and the Centers for Disease Control and Prevention (200-2005-13434); Sanofi- aventis (B09-39223); The California Endowment (20052634); Missouri Founda- tion for Health (08-0006-HPC-08); Connecticut Health Foundation (unnumbered); Merck and Co., Inc. (unnumbered); United Health Foundation (unnumbered); and Kaiser Permanente. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. This summary is based on the proceedings of a workshop that was sponsored by the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities. It is prepared in the form of a workshop summary by and in the name of the rapporteur as an individually authored document. International Standard Book Number-13: 978-0-309-18745-9 International Standard Book Number-10: 0-309-18745-1 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap. edu. For more information about the Institute of Medicine, visit the IOM home page at, www.iom.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2011. State and Local Policy Ini- tiatives to Reduce Health Disparities: Workshop Summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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MEMBERS OF THE PLANNING COMMITTEE1 NICOLE LURIE2 (Chair), The RAND Corporation, Arlington, VA TOM GRANATIR, Humana, Inc., Chicago, IL CARA V. JAMES, Henry J. Kaiser Family Foundation, Washington, DC DAVID P. PRYOR, Aetna, Inc., Thousand Oaks, CA MILDRED THOMPSON, PolicyLink, Oakland, CA 1 Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the Institute of Medicine. 2 Resigned June 2009. v

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MEMBERS OF THE ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY AND THE ELIMINATION OF HEALTH DISPARITIES1 NICOLE LURIE2 (Chair), The RAND Corporation, Arlington, VA WILLIAM VEGA3 (Chair), Professor, University of California, Los Angeles MILDRED THOMPSON (Cochair), Senior Director, PolicyLink PATRICIA BAKER, President and Chief Executive Officer, The Connecticut Health Foundation ANNE C. BEAL, President, Aetna Foundation AMERICA BRACHO, Chief Executive Officer, Latino Health Access FRANCIS D. CHESLEY, Director, Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality JAMILA DAVISON, Instructor, Emory University ALLAN GOLDBERG, Executive Director, Science Affairs Cardiovascular/ Metabolic Business Unit, U.S. Pharmaceuticals, Merck & Co., Inc. GARTH N. GRAHAM, Deputy Assistant Secretary for Minority Health, U.S. Department of Health and Human Services TOM GRANATIR, Director, Policy and Research, Humana, Inc. CARA V. JAMES, Senior Policy Analyst, Henry J. Kaiser Family Foundation JENNIE R. JOE, Professor, Department Family and Community Medicine, and Director, Native American Research and Training Center, University of Arizona JAMES R. KIMMEY, President and Chief Executive Officer, Missouri Foundation for Health JAMES KRIEGER, Chief, Chronic Disease and Injury Prevention Section, Seattle King County Health Department ANNE C. KUBISCH, Codirector, The Aspen Institute JEFFREY LEVI, Executive Director, Trust for America’s Health JOHN LEWIN, Chief Executive Officer, American College of Cardiology NEWELL McELWEE, Executive Director, U.S. Outcomes Research, Merck & Co., Inc. GARY D. NELSON, President, Healthcare Georgia Foundation 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the Institute of Medicine. 2 Resigned June 2009. 3 Chair since October 2009. vii

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ELENA O. NIGHTINGALE, Scholar in Residence, Institute of Medicine SAMUEL NUSSBAUM, Executive Vice President and Chief Medical Officer, WellPoint, Inc. TERRI PEDONE, Director, Sanofi-Aventis DAVID P. PRYOR, Medical Director, Aetna, Inc. STEVE M. PU, General Surgeon, Missouri Foundation for Health AMELIE G. RAMIREZ, Director, Institute for Health Promotion Research KYU RHEE, Chief Medical Officer, Health and Human Services JOY SMITH, Executive Director, National Association of State Offices of Minority Health SAMUEL SO, Lui Hac Minh Professor, Stanford University PATTIE TUCKER, Lead Health Scientist, Centers for Disease Control and Prevention SID VOORAKKARA, Program Officer, The California Endowment WINSTON F. WONG, Medical Director, Community Benefit, and Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente TERRI D. WRIGHT, Program Director, Health Policy, W. K. Kellogg Foundation Study Staff KAREN M. ANDERSON, Senior Program Officer ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice PAMELA A. LIGHTER, Senior Program Assistant (until January 2011) COLIN F. FINK, Senior Program Assistant (after January 2011) PATRICK BURKE, Financial Officer (October 2008 through October 2009) AMY M. PRZYBOCKI, Financial Officer (November 2009 to present) HOPE HARE, Administrative Assistant viii

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Meredith Benedict, Anthurium Solutions, Inc. Jamila Davison, Emory University Steve M. Pu, Missouri Foundation for Health Pattie Tucker, Centers for Disease Control and Prevention Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Antonia M. Villarruel. Appointed by the National Research Council, she was responsible for mak- ing certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. ix

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Contents 1 INTRODUCTION 1 Scope of the Workshop, 2 Workshop Agenda, 2 Key Themes, 3 Organization of the Report, 4 2 CHANGING THE CONDITIONS OF COMMUNITIES WHERE PEOPLE LIVE 5 Using Data to Document Health Disparities, 5 The Two Steps Back Framework, 9 Specific Recommendations, 11 Discussion, 12 References, 13 3 THE PHILLIPS-POWDERHORN EXPERIENCE AND THE ALLINA BACKYARD PROJECT 15 Mayor R. T. Rybak, 15 Discussion, 17 Gordon Sprenger, 19 Richard Pettingill, 21 Sanne Magnan, 24 Health Care Reform Efforts, 24 Eliminating Health Disparities Initiative Efforts and Priorities in Minnesota, 25 Working with Policy Makers, 26 xi

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xii CONTENTS Discussion and Questions, 27 References, 31 4 HEALTH DISPARITIES IN GREAT BRITAIN AND MASSACHUSETTS: POLICY SOLUTIONS 33 The Health Care System in England, 33 National Support Teams: Emerging Themes from the Infant Mortality Support Team Visits, 36 Discussion, 40 Health Disparity-Related Activities Under Massachusetts Health Care Reform, 40 Chapter 58: Massachusetts Health Care Reform, 40 Will Universal Coverage Lead to Reductions in Disparities?, 41 Disparities Provisions in Chapter 58, 42 Pay-for-Performance Approaches, 44 Conclusions, 46 Discussion, 46 References, 46 5 REACTOR PANEL 47 Brian Smedley, 47 Winston Wong, 48 Atum Azzahir, 50 Questions and Discussion, 52 Closing Comments, 55 References, 57 Appendixes A A TIME OF OPPORTUNITY: LOCAL SOLUTIONS TO REDUCE INEQUITIES IN HEALTH AND SAFETY 59 B AGENDA 115 C SPEAKER BIOGRAPHICAL SKETCHES 119